Introduction
Methods
Study Objective
Literature Search
Definition of CLD/BPD
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Mild BPD: oxygen requirement for the first 28 days but in room air at 36 weeks post-menstrual age
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Moderate BPD: oxygen requirement for the first 28 days and oxygen <30% at 36 weeks post-menstrual age
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Severe BPD: oxygen requirement for the first 28 days and oxygen >30% or continuous positive airway pressure (CPAP) or mechanical ventilation at 36 weeks post-menstrual age.
Outcomes of Interest
Evaluation of Data
Statement of Ethics Compliance
Results and Discussion
Articles Selected
Incidence of RSV Hospitalization
Study | Country | Design | Definition of BPD/CLD | Odds ratio (95 % CI)a
| |
---|---|---|---|---|---|
BPD/CLD | Other predictors | ||||
Pederson 2003 [49] | Denmark | Retrospective study of 240 infants <28 wGA and/or birthweight <1000 g (12.5% CLD) born 1994–1995, ≤2 years old; 18% rehospitalized for RSV | Continued need for oxygen therapy at 36 weeks post-conceptual age | 2.2 (1.0–5.1) | Discharge between August and October: 2.0 (1.0–3.9) |
Heikkinen 2005 [6] | Finland | Retrospective cohort study of 35,811 children (0.08 % CLD) born 1991–2000; 2.1% hospitalized for RSV | Continued need for oxygen therapy at 36 weeks post-menstrual age or if children <2 years required medical therapy within 6 months before the start of the RSV season | 6.3b (2.2–18.2) | ≤32 wGA without CLD: 3.6b (2.7–4.8); 33–35 wGA: 1.9b (1.4–2.6) |
Liese 2003 [31] | Germany | Retrospective cohort study of 1103 infants ≤35 wGA discharged from NICU (1998–1999); 717 included in final analysis (7.4% CLD); 5.2% re-hospitalized for RSV | Continued need for oxygen therapy beyond 36 weeks post-conceptual age | 3.99 (1.4–11.2) | Male gender: 8.7 (2.6–29.1); day care attendance of siblings: 3.9 (1.9–8.3); discharge between October and December: 2.1 (0.99–4.4) |
Ricart 2012 [29] | Spain | Prospective study of 484 infants <12 months admitted to the pediatric ward or PICU (2007–2008) for acute bronchiolitis; 410 positive for respiratory viruses included in final analysis (29% BPD) | As defined in Jobe and Bancalari [47]: need for oxygen therapy at 36 weeks post-conceptual age | 7.2 (1.2–43.3) | CHD: 4.7 (1.1-19.9); prematurity: 2.6 (1.3–5.1); fever: 1.8 (1.1–3.1) |
Carbonell-Estrany 2000 [36] | Spain | Observational, prospective, longitudinal cohort study of 584 infants ≤32 wGA discharged from 15 Spanish neonatal units 1998–1999 (6.5% CLD); 20.2% re-hospitalized for respiratory disease (66.3% documented RSV infections) | Continued need for oxygen therapy at 36 weeks post-conceptual age | 3.1 (1.22–7.91) | Living with school age siblings: 1.86 (1.01–3.4) |
Erikkson 2002 [38] | Sweden | 12-year retrospective study of 1503 cases of confirmed RSV infection (1987–1998); <24 months old; included infants with CLD (2.2% catchment area; 13% from other areas) | Preterm birth with a need for oxygen at 36 wGA and continuous medicationc during all or part of the 6 months preceding hospitalization | 2.83 (1.08–7.42) | Previously healthy infants with versus without siblings: 2.42 (2.08–2.81); preterm infants without CLD with versus without siblings: 2.20 (1.37–3.53) |
Joffe 1999 [32] | US | Retrospective cohort study of 1721 preterm infants (23–36 wGA) admitted post-NICU discharge at the start of the season (124 CLD); 3.2% re-hospitalized for RSV | Oxygen therapy for ≥28 days in the NICU | 3.7 (1.8–7.6) | 23–32 wGA: 2.6 (1.4–5.1); discharge from NICU September–November: 2.7 (1.6–4.7) |
Study | Country | Study participants | Definition of BPD/CLD | Number of children with CLD/BPD | RSV hospitalization rate (%) |
---|---|---|---|---|---|
IMpact-RSV study 1998 [48] | US, UK and Canada | ≤24 months olda
| Clinical diagnosis of BPD requiring ongoing medical treatment (i.e. supplemental oxygen, steroids, bronchodilators, or diuretics within the previous 6 months) | 266c
| 12.8 |
Pedersen 2003 [49] | Denmark | Preterm infants <28 wGA and/or birthweight <1000 g | Continued need for oxygen therapy at 36 weeks post-conceptual age | 30 | 30.0 |
Heikkinen 2005 [6] | Finland | Preterm infants ≤35 wGAb
| Continued need for oxygen therapy at 36 weeks post-menstrual age or if children <2 years required medical therapy within 6 months before the start of the RSV season | 25 | 12.0 |
Grimaldi 2004 [52] | France | Preterm infants ≤32 wGA | Oxygen dependency at 28 days after birth | 26 | 46.2 |
Liese 2003 [31] | Germany | Preterm infants <35 wGA | Continued need for oxygen therapy at 36 weeks post-conceptual age | 53 | 15.1 |
Carbonell-Estrany 2000 [36] | Spain | Preterm infants ≤32 wGA | Continued need for oxygen therapy at 36 weeks post-conceptual age | 38 | 21.1 |
Deshpande 2003 [41] | UK | Preterm infants <37 wGA | Continued need for oxygen therapy at 36 weeks post-menstrual age | 64 | 15.6 |
Greenough 2001 [50] | UK | Preterm infants <32 wGA | Oxygen dependency beyond 28 days after birth | 235 | 19.1 |
Thomas 2000 [51] | UK | Preterm infants <32 wGA | Continued need for oxygen therapy at 36 weeks post-conceptual age | 34 | 8.8 |
Joffe 1999 [32] | US | Preterm infants ≤36 wGA | Oxygen therapy for ≥28 days in the NICU | 124 | 14.5 |
Group | RSV hospitalization rate per 1000 children | |
---|---|---|
First year of life | Second year of life | |
BPD | 388 | 73 |
CHD | 92 | 18 |
≤28 wGA | 70 | 30 |
29 to <33 wGA | 66 | 8 |
33 to <36 wGA | 57 | 11 |
Term (with no underlying medical condition) | 30 | 4 |
Morbidity and Healthcare Resource Utilization
Study | Country (timeframe) | Study participants | Definition of BPD/CLD | Length of hospital stay, median days (IQR) | ICU admission (%) | Oxygen therapy (%) | Mechanical ventilation (%) | Case-fatality rate (%) |
---|---|---|---|---|---|---|---|---|
Erikkson 2002 [38] | Sweden (1987–1998) | 49 children with CLD hospitalized with RSV (median age: 9.1 months) vs. 108 children without CLD hospitalized with RSV (median age: 2.9 months) vs. 1212 children without risk factorsa hospitalized with RSV (median age: 2.3 months) | Preterm infant requiring oxygen at 36 wGA and continuous medicationb during all/part of the 6 months preceding hospitalization | 8 (4–30) vs. 5 (2–9) vs. 3 (2–4) | 29 vs. 34 vs. 13 | NR | 24 vs. 10 vs. 2 | 2.0 vs. 0.9 vs. 0.2 |
Duppenthaler 2001 [58] | Switzerland (1998–2000) | 9 children with CLD hospitalized with RSV (median age: 9.3 months) vs. 216 children born >35 wGA without CLD hospitalized with RSV (median age: 3.7 months) | NR | 8 (2–17)c vs. 6.4 (1–30)c
| 0 vs. 11.6 | NR | NR | 0 vs. 0.5 |
Thomas 2000 [51] | UK (1995–1997) | 3 children with CLD hospitalized with RSV (median age: NR) | Continued need for oxygen therapy at 36 weeks post-conceptual age | 18d; 16e
| NR | NR | NR | 0 |
Deshpande 2003 [41] | UK (1996–1999) | 10 children with CLD hospitalized with RSV (median age: 53 weeks) vs. 53 children born ≤36 wGA hospitalized with RSV (median age: 23.7 weeks) | Continued need for oxygen therapy at 36 weeks post-menstrual age | 3.5 (2–9) vs. 2 (1–4) | NR | NR | NR | NR |
Zaw 2003 [57] | UK (1995–1999) | 4 children with RSV infection who developed BPD in SCBU (median age: NR) vs. children without BPD (median age: NR) | Oxygen dependency beyond 28 days after birth | 10.5 vs. 2.5 (P = 0.04) | NR | 100 vs. 28.6 (P = 0.02) | NR | NR |
Healthcare Costs
Case-Fatality Rates
Limitations
Conclusions
Summary box
Key statements/findings | Level of evidencea
|
---|---|
CLD/BPD is a highly significant independent risk factor for RSVH (OR 2.2–7.2) | Level 1 (level 1 studies: n = 2; risk of biasb: 11.0) |
CLD/BPD has been associated with a higher rate of RSVH than other high-risk groups (e.g. CHD, preterm without comorbidities) and term infants | Level 1 (level 1 studies: n = 3; risk of biasb: 10.7) |
The reported incidence of RSVH in infants and young children with CLD/BPD who have not received RSV immunoprophylaxis mostly varies between 12 and 21% | Level 1 (level 1 studies: n = 3; risk of biasb: 10.7) |
Median stay in hospital for RSV infection in children with CLD/BPD is 4–11 days | Level 1–2 (level 1 studies: n = 1; level 2 studies: n = 2; risk of biasb: 10.7) |
CLD/BPD is significantly and independently associated with a complicated course of disease, involving use and duration of mechanical ventilation and requirement for ECMO support | Level 1–3 (level 1 studies: n = 1; level 3 studies: n = 1; risk of biasb: 10.0) |
Key areas for research | |
More up-to-date research and specific studies are needed on the burden of severe RSV infection in infants and young children with CLD/BPD | |
Comparison of the morbidity and mortality incurred by infants with “OLD” versus “NEW” CLD/BPD |